Senators examine impact of prenatal care changes

Lawmakers heard testimony Nov. 19 on the impact of a recent change in Nebraska’s Medicaid coverage of prenatal care.

In 2009, the federal government notified Nebraska officials that the state could no longer provide medical services for unborn children under Medicaid. However, the notice indicated that Nebraska could establish a separate state program for prenatal care under the targeted low-income child health option of the Children’s Health Insurance Program (CHIP).

Lincoln Sen. Kathy Campbell introduced a bill during the 2010 session that would have required the state Department of Health and Human Services to establish such a program solely for the unborn children of mothers who are ineligible for coverage under Medicaid. Campbell requested the bill be bracketed, citing a lack of support, and HHS ceased providing medical services for unborn children under Medicaid on March 1.

LR501, sponsored by Campbell, established a select legislative committee to conduct an interim study on the impact of this change. The committee, composed of three members each of the Health and Human Services and Judiciary committees and three at-large members, heard testimony from health care providers and advocates from across the state.

Rebecca Rayman, executive director of the Good Neighbor Community Health Center in Columbus, testified that the number of low-birth weight babies and stillbirths at the center has increased in the seven months since the change took effect.

There have been four stillbirths among the center’s patients in the last seven months, compared with none in the previous six years, Rayman said. Noting that early access to prenatal care is vital in managing pregnancies, she also cited a decrease in the percentage of women at the center who enter prenatal care in the first trimester – from over 80 percent last year to 32 percent currently.

“The change in Medicaid has had a negative effect on when women first come in for prenatal care,” Rayman said. “This is a problem that keeps getting worse.”

Andrea Skolkin of One World Community Health Center in Omaha said the full impact of the change is yet to be seen.

So far, the center has seen a 12 percent increase in the number of women seeking prenatal care, she said, and two women have given birth at the center because they feared the cost of going to the hospital. One of those children, born to a woman who had received no prenatal care, did not survive, Skolkin said.

Paul Welch, an obstetrician-gynecologist from Columbus, said health care is not the forum for dealing with immigration issues. The children of women who are in the country illegally become citizens upon birth, he said, and the state will bear financial responsibility for any negative outcomes of their lack of prenatal care.

“They are the next generation of Americans,” Welch said, “whether we like it or not.”

Jennifer Carter of Nebraska Appleseed urged the committee to require HHS to amend the state Medicaid plan and reinstate prenatal care for all low-income women. The current policy is taking a fiscal as well as human toll on the state, she said, noting the expense of treating defects caused by inadequate prenatal care.

“We’re already seeing some devastating consequences,” Carter said.

Campbell said the committee will continue data gathering and analysis for a report due to the Legislature by Dec. 31.